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Hegde K, Chandrashekarappa S, Patel S, Shetty S, Prakash BG. The Nasal Microarchitecture: How Does Tracheostomy Affect it? Indian J Otolaryngol Head Neck Surg 2024; 76:842-845. [PMID: 38440435 PMCID: PMC10908945 DOI: 10.1007/s12070-023-04290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 03/06/2024] Open
Abstract
This study aims to evaluate the histological changes in the nasal mucosa post Tracheostomy. A prospective observational study was done on 30 patients undergoing Tracheostomy after obtaining written informed consent from patients/legally accepted representatives. Prior to Tracheostomy, anterior rhinoscopy was done, and findings were noted; nasal mucosal biopsy was obtained from the inferior turbinate. The patients enrolled were followed up for four weeks, and in the patients still having Tracheostomy, repeat inferior turbinate biopsies were taken and compared. Statistically significant atrophy of lining epithelium was seen in 80% of the subjects, i.e., pseudostratified lining epithelium at Baseline with multilayered appearance changed to a single layer of flattened cells at follow-up. There was also a marked reduction in the number of seromucinous glands in the stroma at follow-up in 80% of the subjects. Additionally, fibrosis in the stroma was noted in 43.3% of subjects at follow-up. The results from this study indicate that Tracheostomy, likely as a result of nasal airflow deprivation, brings about significant changes in the microanatomy of the nasal airway. The extent of this causation and its implication in nasal pathology must be studied in larger populations with extended follow-up periods.
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Affiliation(s)
- Kiran Hegde
- Department of Otorhinolaryngology, JSS Medical College, Mysore, India
| | | | - Sapna Patel
- Department of Pathology, JSS Medical College, Mysore, India
| | - Sandeep Shetty
- Department of Otorhinolaryngology, JSS Medical College, Mysore, India
| | - B. G. Prakash
- Department of Otorhinolaryngology, JSS Medical College, Mysore, India
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Zhang Y, Hu Z, Wang Y, Lou M, Ma R, Gong M, Dong J, Zheng G, Wang B. Numerical investigation of nanoparticle deposition in the olfactory region among pediatric nasal airways with adenoid hypertrophy. Comput Biol Med 2023; 167:107587. [PMID: 37890422 DOI: 10.1016/j.compbiomed.2023.107587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
To understand inhaled nanoparticle transport and deposition characteristics in pediatric nasal airways with adenoid hypertrophy (AH), with a specific emphasis on the olfactory region, virtual nanoparticle inhalation studies were conducted on anatomically accurate child nasal airway models. The computational fluid-particle dynamics (CFPD) method was employed, and numerical simulations were performed to compare the airflow and nanoparticle deposition patterns between nasal airways with nasopharyngeal obstruction before adenoidectomy and healthy nasal airways after virtual adenoidectomy. The influence of different inhalation rates and exhalation phase on olfactory regional nanoparticle deposition features was systematically analyzed. We found that nasopharyngeal obstruction resulted in significant uneven airflow distribution in the nasal cavity. The deposited nanoparticles were concentrated in the middle meatus, septum, inferior meatus and nasal vestibule. The deposition efficiency (DE) in the olfactory region decreases with increasing nanoparticle size (1-10 nm) during inhalation. After adenoidectomy, the pediatric olfactory region DE increased significantly while nasopharynx DE dramatically decreased. When the inhalation rate decreased, the deposition pattern in the olfactory region significantly altered, exhibiting an initial rise followed by a subsequent decline, reaching peak deposition at 2 nm. During exhalation, the pediatric olfactory region DE was substantially lower than during inhalation, and the olfactory region DE in the pre-operative models were found to be significantly higher than that of the post-operative models. In conclusions, ventilation and particle deposition in the olfactory region were significantly improved in post-operative models. Inhalation rate and exhalation process can significantly affect nanoparticle deposition in the olfactory region.
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Affiliation(s)
- Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China
| | - Zhenzhen Hu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China; School of Engineering, RMIT University, Bundoora, VIC, 3083, Australia
| | - Yusheng Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China
| | - Miao Lou
- Department of Otorhinolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Ruiping Ma
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China
| | - Minjie Gong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China
| | - Jingliang Dong
- Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia; First Year College, Victoria University, Footscray Park Campus, Footscray, VIC, 3011, Australia.
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China.
| | - Botao Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China.
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Tzironi G, Zubizarreta-Macho Á, Brunsó-Casellas J, Cabriada-Nuño V, Lobo Galindo AB, Albaladejo Martínez A, De Carlos-Villafranca F. Nasal and maxillary sinus volume change in patients with obstructive sleep apnea after bimaxillary advancement surgery. BMC Oral Health 2023; 23:879. [PMID: 37978478 PMCID: PMC10656828 DOI: 10.1186/s12903-023-03657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023] Open
Abstract
The airway complex is modified by bimaxillary advancement surgery performed in patients suffering from obstructive sleep apnea (OSA). The aim of the present study is to analyse the volume of nasal and maxillary sinus after bimaxillary advancement surgery in patients suffering from OSA. The maxillary sinus and nasal complex of eighteen patients with OSA was measured through cone-beam computed tomography (CBCT) before and after they were treated with bimaxillary advancement surgery. Digital planning software was used to effectively measure the upper volume changes, as well as, statistical analysis of the results was performed.Methods Eighteen patients were diagnosed with OSA the severity of which was measured by the apnea hypopnea index and were selected and submitted to preoperative and postoperative CBCT scans. Afterwards, datasets were uploaded into therapeutic digital planning software (Dolphin Imaging) to measure the volume of the right and left maxillary sinus and nasal and maxillary sinus complex. Statistically analysis between preoperative and postoperative measures was performed by Student t-test statistical analysis.Results The paired t-test showed statistically significant volumetric reductions in the left maxillary sinus (p = 0.0004), right maxillary sinus (p < 0.0001) and nasal and maxillary sinus complex (p = 0.0009) after bimaxillary advancement surgery performed in patients suffering from OSA.Conclusion The results showed that bimaxillary advancement surgery reduces the maxillary sinus volume as well as, the fossa nasal and sinus complex volume.
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Affiliation(s)
- Georgia Tzironi
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008, Salamanca, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008, Salamanca, Spain.
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691, Madrid, Spain.
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1. 28691. Villanueva de La Cañada, Madrid, Spain.
| | | | - Valentín Cabriada-Nuño
- Sleep and Ventilation Unit, Respiratory Division, Cruces University Hospital, Barakaldo, Spain
| | - Ana Belén Lobo Galindo
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008, Salamanca, Spain
| | | | - Félix De Carlos-Villafranca
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Haque M, Mukhopadhyay S. Objective and Subjective Analysis for Efficaciousness of Nasal Airway in Patients Undergoing Conventional and Endoscopic Septoplasty: A Comparative Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4816-4823. [PMID: 36742918 PMCID: PMC9895268 DOI: 10.1007/s12070-022-03120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/06/2022] [Indexed: 02/07/2023] Open
Abstract
Deviated nasal septum is the most common cause of nasal obstruction and is one of the common problems encountered by otolaryngologists. Although there are different methods to surgically correct a deviated nasal septum which can give qualitative relief to the patient, less emphasis is put on the quantitative assessment of airway after a septal correction surgery. Institution based Case Control study was undertaken at Medical College and Hospital Kolkata between January 2019 to March 2020 to subjectively and objectively assess and compare the nasal airway status preoperatively and postoperatively in patients undergoing conventional and endoscopic septoplasty. A total of 250 patients were taken in this study and divided into two groups A and B. Group A consisted of patients undergoing Conventional Septoplasty (Control arm) and Group B consisted of patients undergoing Endoscopic Septoplasty (Case arm). Patients were followed up and the readings of NOSE score and PNIF value were recorded at the end of 6 weeks and 6 months (24 weeks). The Mean NOSE score post operatively at the end of 6 weeks was 36.32 in GROUP A (Control arm) and 33.08 in GROUP B (Case arm). t-Test revealed insignificant results with a p-value of 0.08. The mean NOSE score post operatively at the end of 6 months was 29.96 in GROUP A (Control arm) and 22.16 in GROUP B (Case arm). t-Test revealed significant results with a p-value of 0.00. Similarly, Mean PNIF value post operatively at the end of 6 weeks was 57.24 in GROUP A (Control arm) and 73.88 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. The mean PNIF value post-operatively at the end of 6 months was 59.44 in GROUP A (Control arm) and 80.08 in GROUP B (Case arm). t-Test revealed significant results with p-value of 0.00. Endoscopic Septoplasty is a very effective way to treat septal deviations especially with deviations based on the posterior aspect of the septum. It provides a superior edge in terms of nasal airway improvement as compared to conventional method of septoplasty. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03120-2.
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Affiliation(s)
- Misbahul Haque
- Department of ENT and Head Neck Surgery, Medical College and Hospital, Kolkata, West Bengal India
| | - Subrata Mukhopadhyay
- Department of ENT and Head Neck Surgery, Medical College and Hospital, Kolkata, West Bengal India
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Gokce G, Gode S, Ozturk A, Kirazlı T, Veli I. Evaluation of the effects of different rapid maxillary expansion appliances on airway by acoustic rhinometry: A randomized clinical trial. Int J Pediatr Otorhinolaryngol 2022; 155:111074. [PMID: 35189449 DOI: 10.1016/j.ijporl.2022.111074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this 3-arm parallel trial was to compare the effects of tooth tissue-borne (TTB), tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME) appliances on nasal airway with acoustic rhinometry (AR). SETTING AND SAMPLE POPULATION Forty-six 12- to 14-year-old patients with narrow maxilla were randomly allocated into 3 study groups accordingly the type of expander: TTB, TB and BB. The participants were recruited from the Department of Orthodontics, Izmir Katip Celebi University. MATERIALS AND METHODS All patients had RME with an initial activation of two-quarter turns a day (0.5 mm) for an average of 8 days followed by 1 quarter turns per day for an average of 10 days. Disguised group allocation using opaque sealed envelopes was made with a computer-generated randomization program. The primary outcome was changes on the minimal nasal cross-sectional area (MCA). Secondary outcome included the assessment of nasal cavity volume. AR measurements were obtained at baseline (T0), immediately after the expansion (T1), and at 3 months-follow-up (T2). One-way analysis of variance (ANOVA) and Bonferroni test were used for inter-group comparison and two-way ANOVA was used for intra-group evaluation. RESULTS There were significant increases in MCA 1, 2 and nasal Vol in all groups after the treatment (95% [CI], P < 0.05) whereas in inter-group comparisons; MCA 1, 2 and nasal Vol, the changes were found to be similar (95% [CI], P > 0.05). HARMS No serious harm was observed except for mild gingivitis due to plaque accumulation. CONCLUSIONS RME treatment increased minimal nasal cross-sectional areas and nasal volume irrespective of appliance design. TRIAL REGISTRATION This trial was registered at Clinicaltrials.gov (Identifier NCT04529057). PROTOCOL The protocol was not published. FUNDING This trial was financed by Izmir Katip Celebi University, Scientific Research Projects Unit [grant number 2016-TDR-SABE-0024].
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Affiliation(s)
- Gokcenur Gokce
- Izmir Katip Celebi University, Faculty of Dentistry, Department of Orthodontics, Turkey.
| | - Sercan Gode
- Department of Otolaryngology, Ege University School of Medicine, Turkey.
| | - Arın Ozturk
- Department of Otolaryngology, Ege University School of Medicine, Turkey.
| | - Tayfun Kirazlı
- Department of Otolaryngology, Ege University School of Medicine, Turkey.
| | - Ilknur Veli
- Izmir Katip Celebi University, Faculty of Dentistry, Department of Orthodontics, Turkey.
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Kamburoglu HO, Bitik O, Vargel İ. Airflow Considerations and the Effect of Webster's Triangle in Reduction Rhinoplasty. Aesthetic Plast Surg 2021; 45:2244-2254. [PMID: 33598741 DOI: 10.1007/s00266-021-02168-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reduction rhinoplasties, regardless of the methods used (structural or preservation), can cause a reduction in the internal nasal volume, which may lead to breathing problems. In 1977, Webster proposed preserving a little triangle in the beginning of the lower lateral osteotomy line to prevent breathing problem. However, its importance is still controversial. OBJECTIVES and methods: This prospective randomized controlled study (level of evidence 1) included 46 patients without nasal breathing problem. High-to-low (Webster's triangle preservation) osteotomy (control group, n = 23) and low-to-low osteotomy (study group, n = 23) were performed. All operations were performed according to the proposed volumetric rhinoplasty steps (examination/measurement, prevention and treatment). Nasal obstruction symptom evaluation (NOSE) test, visual analog scale, acoustic rhinometry, rhinomanometry, peak nasal inspiratory flow (PNIF), and three-dimensional measurements were performed in all patients. Breathing tests were repeated before and 6 months after surgery with and without xylometazoline administration. RESULTS No statistically significant difference in NOSE and visual analog scale scores was found between the two groups. Acoustic rhinometry, PNIF, and rhinomanometry findings showed no statistically significant breathing difference between the two groups. CONCLUSIONS In reduction rhinoplasties, a decrease in the internal volume may be expected as directly proportional with the reduction amount. The decrease in the internal volume may create nasal breathing problems. To prevent it, nasal airflow should be adjusted according to new anatomy. In this study, we discussed "volumetric rhinoplasty" steps to prevent breathing problems in reduction rhinoplasty. Following these steps, not preserving Webster's triangle (low-to-low osteotomy) has no effect on the nasal airway. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Haldun O Kamburoglu
- Private Practice, Koc Ikiz Kuleleri A Blok No 57 Sogutozu, Cankaya, 06520, Ankara, Turkey.
| | | | - İbrahim Vargel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Stassen THA, Bartley J, White DE. Inhaled nasopharyngeal nitric oxide concentrations during unilateral nostril breathing - A pilot study. Respir Physiol Neurobiol 2021; 293:103734. [PMID: 34214661 DOI: 10.1016/j.resp.2021.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022]
Abstract
The yogic pranayama technique of unilateral nostril breathing (UNB) has previously demonstrated improvements in language and anxiety in stroke sufferers, as well as reduced blood pressure and increased heart rate in normal healthy adults. The nose typically passes different amounts of air through each nostril with the greater amount of air passing through the 'patent' side, and a lesser amount through the 'congested' side. Each side of the nose periodically takes turns at carrying the dominant tidal air flow in what is termed the' nasal cycle'. The nasal sinuses are a rich source of inhaled nitric oxide, a colourless and odourless gas that acts as a bronchodilator, vasodilator, and neurotransmitter. Nasal derived nitric oxide (NO) may contribute to the benefits attributed to UNB. This investigation seeks to assess the influence the nasal cycle has on inhaled nasopharyngeal NO concentrations during UNB by comparing unobstructed bilateral nostril breathing to patent-side and congested-side UNB in healthy individuals demonstrating a nasal cycle. After determining the patent and congested nasal sides in healthy adult volunteers, and sampling air at both nostrils, nasopharyngeal inhaled NO concentrations were then assessed during normal nasal at-rest tidal breathing during three different nasal breathing states: first both nostrils, then allocated in randomised order, patent side only, and congested side with only UNB. Nasopharyngeal NO concentrations were found to be consistently higher on both exhalation and inhalation during congested side UNB, when compared with either unilateral patent side UNB or breathing through both nostrils.
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Affiliation(s)
- Tim H A Stassen
- Zuyd University of Applied Sciences, Maastricht, the Netherlands
| | - Jim Bartley
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - David E White
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
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Abstract
Rhinoplasty is a double-edged sword regarding the functional nasal airway; it can enhance and improve the nasal airway if done properly, and can severely compromise the nasal airway if not done properly. The composition of the nasal airway includes the internal and external nasal valves, nasal septum, and inferior turbinates. Each of these areas can be addressed by several techniques, described in the body of the text. Nasal septal perforation is another potential complication that may result from septal surgery, which has nonsurgical and surgical methods to treat, and is also described in the body of the text.
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Affiliation(s)
- Keith A Sonneveld
- FACES Fort Worth, 4421 Oak Park Ln Ste 101, Fort Worth, TX 76109, USA.
| | - Pradeep K Sinha
- Atlanta Institute for Facial Aesthetic Surgery, 5730 Glenridge Drive, Suite T200, Atlanta, GA 30328, USA
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Abstract
Empty nose syndrome (ENS) is a controversial condition associated with disruption of nasal airflow caused by excessive loss of turbinate tissue. ENS arises after total or near-total inferior turbinate resection. Patients present with intense fixation on the perception of nasal obstruction. Diagnostic tools to assess for empty nose syndrome include a validated patient questionnaire and the office cotton test. Treatment involves topical moisturization, behavioral/psychiatric assessment/treatment, and surgical reconstruction. Current data show promising long-term efficacy after surgical intervention. Postprocedural ENS is best prevented by minimizing inferior and middle turbinate tissue loss.
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Affiliation(s)
- Jason Talmadge
- Department of Otolaryngology, Medical College of Wisconsin, 3400 Market Lane, Kenosha, WI 53144, USA
| | - Jayakar V Nayak
- Department of Otolaryngology, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - William Yao
- Department of Otolaryngology, Medical College of Wisconsin, 3400 Market Lane, Kenosha, WI 53144, USA
| | - Martin J Citardi
- Department of Otorrhinolaryngology, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street, MSB 5.036, Houston, TX 77030, USA.
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Zhang C, Bruggink R, Baan F, Bronkhorst E, Maal T, He H, Ongkosuwito EM. A new segmentation algorithm for measuring CBCT images of nasal airway: a pilot study. PeerJ 2019; 7:e6246. [PMID: 30713816 PMCID: PMC6354662 DOI: 10.7717/peerj.6246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022] Open
Abstract
Background Three-dimensional (3D) modeling of the nasal airway space is becoming increasingly important for assessment in breathing disorders. Processing cone beam computed tomography (CBCT) scans of this region is complicated, however, by the intricate anatomy of the sinuses compared to the simpler nasopharynx. A gold standard for these measures also is lacking. Previous work has shown that software programs can vary in accuracy and reproducibility outcomes of these measurements. This study reports the reproducibility and accuracy of an algorithm, airway segmentor (AS), designed for nasal airway space analysis using a 3D printed anthropomorphic nasal airway model. Methods To test reproducibility, two examiners independently used AS to edit and segment 10 nasal airway CBCT scans. The intra- and inter-examiner reproducibility of the nasal airway volume was evaluated using paired t-tests and intraclass correlation coefficients. For accuracy testing, the CBCT data for pairs of nasal cavities were 3D printed to form hollow shell models. The water-equivalent method was used to calculate the inner volume as the gold standard, and the models were then embedded into a dry human skull as a phantom and subjected to CBCT. AS, along with the software programs MIMICS 19.0 and INVIVO 5, was applied to calculate the inner volume of the models from the CBCT scan of the phantom. The accuracy was reported as a percentage of the gold standard. Results The intra-examiner reproducibility was high, and the inter-examiner reproducibility was clinically acceptable. AS and MIMICS presented accurate volume calculations, while INVIVO 5 significantly overestimated the mockup of the nasal airway volume. Conclusion With the aid of a 3D printing technique, the new algorithm AS was found to be a clinically reliable and accurate tool for the segmentation and reconstruction of the nasal airway space.
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Affiliation(s)
- Chen Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Robin Bruggink
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.,3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Frank Baan
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.,3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Section of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Thomas Maal
- 3DLAB The Netherlands, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Hong He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Edwin M Ongkosuwito
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
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Inoue S, Tamaki Y, Sonobe S, Egawa J, Kawaguchi M. A pediatric case developing critical abdominal distension caused by a combination of humidified high-flow nasal cannula oxygen therapy and nasal airway. JA Clin Rep 2018; 4:4. [PMID: 29457114 PMCID: PMC5804666 DOI: 10.1186/s40981-017-0143-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 11/11/2022] Open
Abstract
Background We describe a pediatric patient who suffered from critical abdominal distention caused by a combination of humidified, high-flow nasal cannula (HHFNC) oxygen therapy and nasal airway. Case presentation A 21-month-old boy with a history of chronic lung disease was admitted to the intensive care unit (ICU). Immediately after admission, his airway was established using a tracheal tube and mechanical ventilation was started. Five days after the commencement of mechanical ventilation, finally, his trachea was extubated. Immediately after extubation, HHFNC therapy at 20 L/min with an FiO2 of 0.35 was applied. However, severe stridor was observed, then a nasal airway was placed in the left nostril. However, he became restless. Critical abdominal distention was observed. A subsequent chest X-ray revealed that the nasal airway was placed too deeply, and the gastrointestinal air was severely accumulated. Immediately, the nasal airway was removed, and HHFNC flow was reduced to 10 L/min. Frequent suctioning and continuous gastric drainage were required, which achieved gradual improvement of respiratory condition. Conclusions We need to recognize that HHFNC therapy is one of the positive pressure ventilation system. Therefore, HHFNC therapy might cause the similar adverse events to noninvasive pressure ventilation.
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Affiliation(s)
- Satoki Inoue
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan.
| | - Yumiko Tamaki
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
| | - Shota Sonobe
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
| | - Junji Egawa
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara, 634-8522, Japan
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Özdoğan F, Özel HE, Esen E, Altıparmak E, Genç S, Selçuk A. An often neglected area in crooked nose: middle turbinate pneumatization. Braz J Otorhinolaryngol 2016; 83:563-567. [PMID: 27472981 PMCID: PMC9444759 DOI: 10.1016/j.bjorl.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. Objective To investigate the association between crooked nose and the presence of a BMT. Methods A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. Results Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p = 0.011). Conclusion This study revealed a link between crooked nose and BMT.
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Affiliation(s)
- Fatih Özdoğan
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey.
| | - Halil Erdem Özel
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Erkan Esen
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Erdem Altıparmak
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Selahattin Genç
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
| | - Adin Selçuk
- Derince Research and Training Hospital, Department of Otolaryngology, Kocaeli, Turkey
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Abstract
The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction.
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Affiliation(s)
- Jarrod Keeler
- Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Sam P Most
- Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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Bahmanzadeh H, Abouali O, Faramarzi M, Ahmadi G. Numerical simulation of airflow and micro-particle deposition in human nasal airway pre- and post-virtual sphenoidotomy surgery. Comput Biol Med 2015; 61:8-18. [PMID: 25862997 DOI: 10.1016/j.compbiomed.2015.03.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/19/2015] [Accepted: 03/14/2015] [Indexed: 11/23/2022]
Abstract
In the present study, the effects of endoscopic sphenoidotomy surgery on the flow patterns and deposition of micro-particles in the human nasal airway and sphenoid sinus were investigated. A realistic model of a human nasal passage including nasal cavity and paranasal sinuses was constructed using a series of CT scan images of a healthy subject. Then, a virtual sphenoidotomy by endoscopic sinus surgery was performed in the left nasal passage and sphenoid sinus. Transient airflow patterns pre- and post-surgery during a full breathing cycle (inhalation and exhalation) were simulated numerically under cyclic flow condition. The Lagrangian approach was used for evaluating the transport and deposition of inhaled micro-particles. An unsteady particle tracking was performed for the inhalation phase of the breathing cycle for the case that particles were continuously entering into the nasal airway. The total deposition pattern and sphenoid deposition fraction of micro-particles were evaluated and compared for pre- and post-surgery cases. The presented results show that sphenoidotomy increased the airflow into the sphenoid sinus, which led to increased deposition of micro-particles in this region. Particles up to 25 μm were able to penetrate into the sphenoid in the post-operation case, and the highest deposition in the sphenoid for the resting breathing rate occurred for 10 μm particles at about 1.5%.
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Abstract
INTRODUCTION Our aim was to determine the presence of a correlation between the nasal airway skeletal transverse dimension and air intake changes in rapid maxillary expansion treatments. METHODS Sixty-one patients with maxillary transverse deficiency (11-17 years old) were randomly allocated into three groups (two treatment groups - tooth- [hyrax] or bone-borne [miniscrew-implant-based] expander - and one control group). Cone-beam computed tomography scans (CBCT) were obtained from each patient as well as acoustic rhinometry (AR) readings. Specifically, in AR, airway volume up to minimum cross-sectional areas (Vol. 1&2) and minimum cross-sectional areas (Min. 1&2) in the nasal cavity were measured. Records were obtained at two time points (initial T1 and at removal of appliance at 6 months T2). CBCTs were analyzed using AVIZO software and landmarks were placed on the nasal base. Descriptive statistics were compiled and student's t-test was used. RESULTS Of the 480 pairings measured, only 9 showed statistically significant positive correlations between T1 and T2. Correlation data were highly variable in all categories, showing no clear tendencies. No statistical difference was found when comparing all groups in terms of airway changes. CONCLUSION With very few positive correlations observed and otherwise highly variable data, no really conclusive finding was obtained to suggest any realistic correlation between changes in the skeletal dimensions and changes in the nasal airway.
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